Apart from regional blocks, there are numerous avenues where ultrasound has been utilized by Anesthesiologists.

1. Ultrasound probe in the hands
of Anesthesiologist

2.  Ultrasound imaging
 simple and noninvasive technique to provide a more
accurate clinical assessment and localization of area of
interest
 Modern ultrasound machines are more compact and
portable, with better resolution and enhanced tissue
penetration for identification and desired
intervention in various body structures
Introduction

3. Introduction

4.  Anesthesiologists require quick and accurate
diagnostic tools for the effective management of
emergencies.
 Ultrasound (US) is a safe, easily accessible point-of-
care imaging modality that is being increasingly
adopted in modern anesthesiology practice.
Introduction

5.  As physician-performed ultrasound becomes more
practical and practiced, it is important to assure that
anesthesiologists are aware of the expanding
applications of this technology and the status of its
use.
Introduction

6. Regional anesthesia
Vascular access
Focussed Transthoracic Echo (TTE)
Transesophageal echo (TEE) and Doppler
Lung ultrasound
Airway assessment
Ultrasound neuromonitoring
Current and potential future
applications

7. Ultrasound for Regional Anesthesia

8.  Ultrasound has become a commonly used modality in
the performance of chronic pain interventions and
has begun to substitute for CT scans and fluoroscopy
in many chronic pain procedures.
 It allows direct visualization of tissue structure while
allowing real-time guidance of needle placement and
medication administration.
Neuraxial and Chronic Pain
Procedures

9. Nerve root blocks
Stellate ganglion blocks
transforaminal injections for
radicular pain
intra-articular joint injections
Neuraxial and Chronic Pain
Procedures

10. Vascular Access

11.  Ultrasound imaging indicates the presence, patency,
position, and direction of vessels
 Advantages
 identification of the vein
 detection of variable anatomy and intravascular thrombi
 avoidance of inadvertent arterial puncture
Vascular Access

12.  This may be particularly useful in hemodialysis
patients, high-risk and difficult patients who need
large- bore dual lumen catheters, present for
repeated cannulation, may not be able to lie supine,
and may have underlying coagulopathy or platelet
dysfunction
 Valves and thrombi can also be located
Vascular Access

13.  Ultrasound can also be used for localization of central
vein catheters and detection of postprocedural
pneumothorax, as an alternative to chest radiography
Vascular Access

14.  Ultrasound-guided vascular access has helped in
various challenging patient positions:
 in sitting patients
 patient with kyphosis and fixed chin-on-chest deformity
 in the prone position
Vascular Access

15.  Ultrasound arterial cannulation
 reducing the number of attempts
 shortening the procedure time
 increasing the success rate, even in children
 A linear or hockey-stick probe can be used
Vascular access

16.  Marked reduction in complication rates after
implementation of US-guided central venous
cannulation approaches.
 Although some complications still happen, rates of
4.6% have been reported, comparing with 10.5% when
using landmark technique, which represents an
absolute risk reduction of 5.9%
Vascular Access

17.  Peripheral vascular access in pediatrics can be very
challenging especially in small, obese, or dehydrated
children or in those with previously failed
venipuncture.
Vascular Access

18. Airway Assessment

19.  Airway ultrasound can visualize and assess the
tongue, oropharynx, hypopharynx, epiglottis, larynx,
vocal cords, cricothyroid membrane, cricoid cartilage,
trachea, and cervical esophagus.
 The posterior pharynx, posterior commissure, and
posterior wall of the trachea cannot be visualized due
to artifacts that are created by the intraluminal air
column
Airway Assessment

20. prediction of difficult airway
evaluation of airway pathologies
• that may affect the choice of airway management (e.g., subglottic
hemangiomas and stenosis), or mandate urgent securing of airway (e.g.,
Epiglottitis)
confirmation of proper endotracheal tube placement and
ventilation
Current and potential applications of
airway ultrasound

21. prediction of size of endotracheal, endobronchial, and
tracheostomy tubes
assessing and guidance for percutaneous dilatational
tracheostomy (PDT)
prediction of successful extubation
•(a) prediction of airway edema;(b) assessment of the diaphragm
movement; (c) assessment of vocal cord movements
Current and potential applications of
airway ultrasound

22. Current and potential applications of
airway ultrasound
 Ultrasound is successfully improving the performance
of airway related nerve blocks, including superior
laryngeal nerve, deep cervical plexus, alveolar nerve,
and superficial trigeminal nerve.

23. Current and potential applications of
airway ultrasound
 Although endoscopy is still considered the gold
standard for diagnosis of vocal cord palsy, the
noninvasive nature and portability make ultrasound a
good screening tool pre- and postthyroidectomy.

24. Lung Ultrasound

25.  In a number of emergency situations, hypoxia will
require urgent and appropriate diagnosis for its
management
 Pneumothorax, pulmonary edema, pulmonary
embolism, and ARDS are situations where ultrasound
can be an important tool for diagnosis
 However, it has some limitations when used in patients with
subcutaneous emphysema, pleural calcifications, and in the
obese
Lung Ultrasound

26. diagnosis of
pneumothorax
diagnosis of pulmonary
consolidation and
pneumonia
diagnosis of atelectasis
diagnosis of pulmonary
embolism
Current and potential applications of
lung ultrasound

27. diagnosis and differentiation
of underlying cause of
Pleural effusion
selecting the optimal
puncture site for
pleurocentesis
monitoring of lung disease
(severity, progress, and
response to therapy)
optimizing mechanical
ventilation
Current and potential applications of
lung ultrasound

28. Ultrasound Neuromonitoring

29.  Ultrasound is useful in assessing elevated ICP and
cerebral perfusion
 Current and potential applications of neuro-
ultrasound are:
 optic nerve sheath diameter (ONSD) measurement
 transcranial Doppler ultrasound (TDU)
 pupillary light reflex (PLR)
Ultrasound Neuromonitoring

30.  An increase in ICP will be transmitted through the
subarachnoid space that surrounds the optic nerve
within its sheath and has been proposed as
noninvasive and reliable means of assessing ICP in
neurocritically ill patients
Optic Nerve Sheath Diameter (ONSD)
measurement

31.  Transcranial color coded duplex (TCCD) is an accurate,
real-time, noninvasive (permits bedside examination),
and inexpensive tool used for the study of the
intracranial circulation and the diagnosis of
nonthrombosed aneurysms, largely due to its ability
to reveal flow phenomena
Transcranial color doppler

32.  TCCD can be used for monitoring of cerebral blood
flow alterations which follow traumatic brain injury
and in patients with sickle cell anemia.
 It also can be used in the diagnosis of cerebral
circulatory arrest which is a component of brain death
Transcranial color doppler

33. Ultrasound assessment of the
pupillary light reflex

34. Ultrasound assessment of the
pupillary light reflex
 M-mode measurements are used to measure the
constriction velocity of the PLR.
 This method might be used as pupillometry as well

35. Gastric Ultrasound

36.  A full stomach may lead to aspiration pneumonia and
subsequent morbidities
 Anesthesiologists may encounter patients with
unknown prandial status, and even fasting
“sufficient” time cannot guarantee an empty
stomach in many cases
 e.g., in the elderly or in patients with gastroparesis
 Ultrasound can help in this setting, and the
perioperative evaluation of bowel motility is also
feasible by means of sonography
Gastric Ultrasound

37.  Current and potential applications of Gastric
ultrasound are:
 assessment of gastric content and diagnosis of full
stomach
 confirmation of gastric tube placement
Gastric Ultrasound

38.  Bouvet et al. , measured the antral cross-sectional
area (CSA) in 180 patients after intubation and
analyzed the relationship between antral CSA and the
volume of gastric contents
 The cut-off value of antral CSA of 340mm2 for the
diagnosis of “at risk” stomach was associated with a
sensitivity of 91% and a specificity of 71%
 The area under the receiver operating characteristic (ROC) curve for the
diagnosis of “at-risk” stomach was 90%
Gastric Ultrasound

39.  Confirmation of a gastric tube placement is also
possible using ultrasound, which might replace the
conventional radiography method unless sonography
is inconclusive
Gastric Ultrasound

40. Transthoracic Ultrasound

41.  Focus assessed transthoracic echo (FATE) was
introduced by Jensen et al. for cardiopulmonary
monitoring in the intensive care unit.
 This approach basically involves four standardized
acoustic views for cardiopulmonary screening and
monitoring
Focused Transthoracic Echo (TTE)

42. Focused Transthoracic Echo (TTE)

43. Focused Transthoracic Echo (TTE)
 Focused cardiovascular ultrasound performed by
anesthesiologists in the perioperative period
accurately detects major cardiac pathology and
significantly alters perioperative management

44. Technological Advances

45.  New technologies have greatly improved the image
quality, diagnostic abilities, and size of the US
machine
 These include advances in transducers, scanning
schemes, three- and four- dimensional visualization,
contrast agents (microbubbles), strain imaging etc
Technological Advances

46.  Four-dimensional ultrasound provides real- time 3D
images (the 4th “D” is time) and currently is used for
fetal imaging, where it provides remarkable images
 Endobronchial and endoscopic ultrasounds are two
other new modalities with great and potential
implications
Technological Advances

47.  Small and portable ultrasound systems have become
increasingly available, even a mobile ultrasound-
guided peripheral nerve block has been developed
Technological Advances

48. Summary

49.  Ultrasound is a unique tool which provides the
anesthesiologist with diagnostic and monitoring
capabilities enabling optimization of perioperative
management
 Ultrasound-guided anesthetic procedures have given
a new life to traditional skills
Summary

50.  Indeed, ultrasound has an important role in problem-
based management of various anesthesiology
emergencies such as hypoxia, hypotension, dyspnea,
and cardiopulmonary arrest
Summary

51.  Finally, procedural ultrasound applications in the field
of anesthesiology are numerous and improve the
quality of care
 Ultrasound can be the third eye of the
anesthesiologist that helps in the performance of
previously blind procedures and allows discovery of
many hidden spaces to uncover their mysteries
Summary

52.  Anesthesiologists, in the near future, may need to
carry a portable ultrasound around their neck instead
of a stethoscope
Summary